Generally

The objectives of the Practice Assessment (‘the program’) are to enhance members’ knowledge and encourage excellence in the delivery of care to the public. The program recognizes that continuous quality improvement is a partnership between the College, the member and assessor. The College will provide all the tools and resources to support the practice assessment process. The member, a competent professional and the volunteer assessor (member), a skilled observer, peer mentor and strong advocate for professional education and continuous quality improvement, will collaborate and share their knowledge to improve professional competence and to identify practice trends and patterns within the profession.

The Registrar will randomly select eligible members. The assessor will be appointed by the Quality Assurance committee (“QA”). Podiatrists will assess fellow podiatrists and chiropodists will assess fellow chiropodists, where possible. The assessor, who will be privy to personal and private information about a practitioner and the private health information of patients (in the strictest confidence), is primarily a gatherer and dispenser of facts. The member’s and assessor’s discussions of common struggles and solutions will provide a mentoring relationship between the two parties. It is incumbent on all members of the College to fully cooperate with the practice assessment.

Duties of an Assessor

Assessors are appointees of the Quality Assurance Committee. The assessor is a fellow member who works in a similar practice setting and often struggles to solve similar patient demands, diagnostic mysteries and practice pressures. The role of an assessor offers a unique opportunity to ‘stand in another clinician’s shoes.’ The regulatory authority for the College enables the assessor to require members to fully cooperate and provide access to their practice and charts.

An assessor will contact a member to set up a convenient time for their practice assessment. If extraordinary circumstances warrant an exemption from the practice assessment process, an application to the Registrar can be made. If a member feels that the selected assessor may be biased or may be placed in a conflict while serving in the role of assessor, a written application to the Registrar for an alternate assessor can be made.

The assessor will complete the checklist tools that include the:

• Practice Assessment Tool,
• Surgical Suite Assessment Tool (if applicable),
• Evaluation Grid, and
• Report to the QA committee.

The QA committee will determine the final outcome of an assessment by relying solely on the assessor’s accurate and factual information. Since the assessor is also a peer mentor, he/she must be available for a follow-up interview with the member to informally review any applicable practice management and patient care issues.

The Assessment Process – What to Expect

Each registration year, the program will perform a practice assessment with 5% of the College’s members. The Registrar will randomly select eligible members for the program from all College registrants. Thereafter, the Registrar will contact an appropriate assessor to determine if the assessor will be able to conduct the review. Once selected, it is very important that the member remain available throughout the entire process. The Registrar will notify the member that he/she has been randomly selected and send all checklist tools and documents and the name of the assessor.

Before the assessor visits the member’s clinical site, the pre-assessment Tool will be completed by the member and returned to the Registrar. A Practice Assessment file will then be opened at the College. Thereafter, all pertinent information, including the following, will be sent to the member:

• Policies and Procedures,
• Practice Assessment Tool,
• Chart & Care Plan Review Tool,
• Evaluation Grid,
• Regulatory Authority Statement (see below),
• Bias and Conflict of Interest Statement (see below), and
• Confidentiality Statement (see below).

It will be the assessor’s responsibility to contact the member as soon as possible to setup an assessment time. A written confirmation of appointment will be mailed out to the member.

The Day of the Assessment

The full assessment should be completed in approximately one half of a day. The member will be encouraged to provide a tour of the practice as it will help the assessor complete the practice assessment tool. The assessor will view the practice to ensure that it meets the standards of practice in terms of equipment, infection control measures, record keeping, etc. The assessor will not observe patient care. The member is encouraged to discuss the contents of the practice assessment tool as it is completed. The member will have had the opportunity to review the practice assessment tool prior to the actual assessment. Open commentary is invaluable during this fact gathering session. The final outcome will be decided upon by the Quality Assurance Committee.

The next step in the review is chart assessment. Patient charts will be reviewed for overall trends in patient care and compared to the standards of practice. Individual deficiencies will not be considered a trend. Chart selection will be performed by randomly choosing one or two practice days within the last 12-months. The assessor will select ten charts for review. If the information collected in these charts is not adequate (i.e. does not contain a biomechanical evaluation, surgical procedures that are commonly performed in that practice), then further charts can be selected. The member will be allowed to guide the selection process based upon a “mutually agreed work period”. The assessor may need to request a copy of common abbreviations used in charts. Charts will be reviewed on the premises.

All sections of the checklist tools will be completed and will emphasize both the positive and negative aspects of the practice. Emphasis will be placed on innovation, improved technique and deficiencies. Remarks will be factual and decisive without consideration of consequence or required follow-up. Any checkboxes that are “NO” or “LESS THAN 70%” must be substantiated with comments detailing examples of patient care concerns, practice management failures or falling below standards of practice.

After reviewing the checklist tools and charts, the assessor will complete the evaluation grid and forward it to the Quality Assurance (QA) committee within 14 days. The QA committee will determine the final outcome of the assessment through the use of a Risk Assessment Framework. The member may also make submissions to the QA committee.

At the conclusion of the visit, the assessor will provide the member with the post-assessment tool that seeks comments and feedback about the program. The completion of the post-assessment tool marks the conclusion of the assessment process and allows the release of the evaluation to the member.

Legislative Authority

The Regulated Health Professions Act, 1991

• Section 81 of the Health Professions Procedural Code grants authority to the Quality Assurance Committee to appoint assessors for the purposes of a quality assurance program.
• Section 82 of the Code deal with specifics of the program:
  1. Every member shall co-operate with the Quality Assurance Committee and with any assessor it appoints and in particular every members shall:
     1. permit the assessor to enter and inspect the premises where the member practises;
     2. permit the assessor to inspect the member’s records of the care of patients;
     3. give the assessor or the committee the information in respect of the care of the patients or in respect of the member’s records of the care of patients the Committee or assessor requests in the form the Committee or assessor specifies,
     4. confer with the Committee or assessor if requested to do so by either of them; and
     5. participate in a program designed to evaluate the knowledge, skill and judgment of the member, if requested to do so by the Committee.
  2. Every person who controls the premises where a member practises, other than a private dwelling, shall allow an assessor to enter and inspect the premises.
  3. Every person who controls records relating to a member’s care of patients shall allow an assessor to inspect the records.
  4. Inspection of patient records does not require a patient or his or her representative to allow an assessor to inspect records relating to the patient’s care.
  5. This section applies despite any provision in any Act relating to the confidentiality of health records.

Regulation 203/94 made pursuant to The Chiropody Act, 1991
Part V of the Regulation deals with Quality Assurance.

Section 26 (1) of the Regulation says that the Committee shall administer the quality assurance program, which shall include, amongst others, a Practice assessment. The language is mandatory.

Section 26 (2) states that: Every member shall comply with the requirements of the quality assurance program that apply to him or her.

Section 26(3) says that: The self-assessment and continuing education component, the practice assessment component and the evaluation and remediation components apply only to members who hold a general certificate of registration

Section 30 says:

1. A member is required to undergo a practice assessment under this section if the member,
   1. is selected at random under subsection 30(2);
   2. has been referred to the Committee by the Executive Committee, the Discipline Committee or the Complaints Committee; or
   3. has been referred under clause 29(3)(b) or 5(c) or subsection 29(6).
2. The College shall select at random the names of holders of general certificates required to undergo a practice assessment.
3. A practice assessment (PRP) shall be conducted by an assessor who shall prepare a written report on his or her findings and submit it to the Committee.
4. The Committee shall provide the member with a copy of the Assessor’s report.

Therefore, all members are expected to fully cooperate with the practice assessment process. Assessors must have full access to the practice premises and the premises at which patient charts are maintained.

Confidentiality

The Regulated Health Professions Act, 1991

S. 36 (1) Every person employed, retained or appointed for the purpose of the administration of the Act, a health profession Act or Drug and Pharmacies Regulation Act and every member of a Council or committee of a College shall preserve secrecy with respect to all information that comes to his or her knowledge in the course of his or her duties and shall not communicate any information to any other person.”

There are four exceptions to this rule outlined in section 36 and members are encouraged to review this section of the Act.

Liability

The Regulated Health Professions Act, 1991

S. 36 (2) No person or member described in subsection (1) shall be compelled to give testimony in a civil proceeding with regard to matters that come to his or her knowledge in the course of his or her duties.

S. 36 (3) No record of a proceeding under this Act, a health professions Act or the Drug and Pharmacies Regulation Act, no report, document or thing prepared for or statement given at such a proceeding and no order or decision made in such a proceeding is admissible in a civil proceeding other than a proceeding under this Act, a health profession Act or the Drug and Pharmacies Regulation Act.

Immunity

The Regulated Health Professions Act, 1991

S. 38 states that: No action or other proceeding for damages shall be instituted against the Advisory Council, the Board, a College, a Council or member, officer, employee, agent or appointee of the Advisory Council, the Board, a College, a Council, a committee of a Council or panel of a Committee of a Council for an act done in good faith in the performance or intended performance of a duty or in the exercise or the intended exercise of a power under this Act, a health profession Act, the Drug and Pharmacies Regulation Act or a regulation or a by-law under those Acts or for any neglect or default in the performance or exercise in good faith of the duty of power.

The Quality Assurance Committee and its appointees are afforded an additional level of protection from civil action by the College’s general liability insurance policy.

Conflict of Interest and Bias

There is a strong likelihood that the assessor and member already have had some form of contact with one another. Minimal or collegial contact between the assessor and member is unlikely to result in a conflict of interest or real or perceived bias. Examples of bias could exist with personal relationships (ongoing or past), professional relationships (shared practices, business arrangements, etc), and an existing relationship where one member is in a position of authority to another. Each case is evaluated on its own set of circumstances. Either an assessor or member may claim a conflict of interest or bias and request an alternate person. It could be considered unprofessional conduct to not disclose an apparent conflict and would invalidate the practice assessment process.

All regulatory by-laws regarding confidentiality remain in full effect. The assessor may direct the member to seek additional information from the Registrar at the College if necessary.